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2. Anticoagulant treatment satisfaction with warfarin and direct oral anticoagulants for venous thromboembolism

Author

Fang, Margaret C, Go, Alan S, Prasad, Priya A, Hsu, Jin-Wen, Fan, Dongjie, Portugal, Cecilia, Sung, Sue Hee, and Reynolds, Kristi

Subjects
Pharmacology and Pharmaceutical Sciences, Biomedical and Clinical Sciences, Hematology, Cardiovascular, Administration, Oral, Aged, Anticoagulants, Female, Humans, Male, Personal Satisfaction, Retrospective Studies, Venous Thromboembolism, Warfarin, Venous thromboembolism, Treatment satisfaction, Direct oral anticoagulants, Clinical Sciences, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

Treatment options for patients with venous thromboembolism (VTE) include warfarin and direct oral anticoagulants (DOACs). Although DOACs are easier to administer than warfarin and do not require routine laboratory monitoring, few studies have directly assessed whether patients are more satisfied with DOACs. We surveyed adults from two large integrated health systems taking DOACs or warfarin for incident VTE occurring between January 1, 2015 and June 30, 2018. Treatment satisfaction was assessed using the validated Anti-Clot Treatment Scale (ACTS), divided into the ACTS Burdens and ACTS Benefits scores; higher scores indicate greater satisfaction. Mean treatment satisfaction was compared using multivariable linear regression, adjusting for patient demographic and clinical characteristics. The effect size of the difference in means was calculated using a Cohen's d (0.20 is considered a small effect and ≥ 0.80 is considered large). We surveyed 2217 patients, 969 taking DOACs and 1248 taking warfarin at the time of survey. Thirty-one point five percent of the cohort was aged ≥ 75 years and 43.1% were women. DOAC users were on average more satisfied with anticoagulant treatment, with higher adjusted mean ACTS Burdens (50.18 v. 48.01, p

Published
2021

4. Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The CVRN VTE Study

Author

Fang, Margaret C, Fan, Dongjie, Sung, Sue Hee, Witt, Daniel M, Schmelzer, John R, Williams, Marc S, Yale, Steven H, Baumgartner, Christine, and Go, Alan S

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Hematology, Lung, Clinical Research, Cardiovascular, Good Health and Well Being, Acute Disease, Adult, Aged, Anticoagulants, Cohort Studies, Databases, Factual, Female, Humans, Male, Middle Aged, Multivariate Analysis, Prognosis, Proportional Hazards Models, Pulmonary Embolism, Retrospective Studies, Risk Assessment, Severity of Illness Index, Survival Analysis, Treatment Outcome, Venous Thrombosis, Anticoagulation, Deep venous thrombosis, Mortality, Pulmonary embolism, Venous thromboembolism, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BACKGROUND:Few studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the United States. METHODS:A multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism or deep venous thrombosis during the years 2004 through 2010 was established from 4 large, US-based integrated health care delivery systems. Computerized databases were accessed and medical records reviewed to collect information on patient demographics, clinical risk factors, initial antithrombotic treatment, and vital status. Multivariable Cox regression models were used to estimate the risk of death at 90 days. RESULTS:The cohort comprised 5497 adults with acute venous thromboembolism. Pulmonary embolism was predominantly managed in the hospital setting (95.0%), while 54.5% of patients with lower extremity thrombosis were treated as outpatients. Anticoagulant treatment differed according to thromboembolism type: 2688 patients (92.8%) with pulmonary embolism and 1625 patients (86.9%) with lower extremity thrombosis were discharged on anticoagulants, compared with 286 patients (80.1%) with upper extremity thrombosis and 69 (54.8%) patients with other thrombosis. While 4.5% of patients died during the index episode, 15.4% died within 90 days. Pulmonary embolism was associated with a higher 90-day death risk than lower extremity thrombosis (adjusted hazard ratio 1.23; 95% confidence interval, 1.04-1.47), as was not being discharged on anticoagulants (adjusted hazard ratio 5.56; 95% confidence interval, 4.76-6.67). CONCLUSIONS:In this multicenter, community-based study of patients with acute venous thromboembolism, anticoagulant treatment and outcomes varied by thromboembolism type. Although case fatality during the acute episode was relatively low, 15.4% of people with thromboembolism died within 90 days of the index diagnosis.

Published
2019

9. Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study

Author

Baumgartner, Christine, Fan, Dongjie, Fang, Margaret C, Singer, Daniel E, Witt, Daniel M, Schmelzer, John R, Williams, Marc S, Gurwitz, Jerry H, Sung, Sue Hee, and Go, Alan S

Subjects
Depression, Behavioral and Social Science, Clinical Research, Stroke, Patient Safety, Brain Disorders, Heart Disease, Cardiovascular, Hematology, Mental Health, Good Health and Well Being, Aged, Anticoagulants, Anxiety, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Incidence, Male, Prognosis, Retrospective Studies, Risk Assessment, Risk Factors, Thromboembolism, United States, Warfarin, anxiety, atrial fibrillation, bleeding, depression, stroke, warfarin, Cardiorespiratory Medicine and Haematology
Abstract

Anxiety and depression are associated with worse outcomes in several cardiovascular conditions, but it is unclear whether they affect outcomes in atrial fibrillation (AF). In a large diverse population of adults with AF, we evaluated the association of diagnosed anxiety and/or depression with stroke and bleeding outcomes. The Cardiovascular Research Network WAVE (Community-Based Control and Persistence of Warfarin Therapy and Associated Rates and Predictors of Adverse Clinical Events in Atrial Fibrillation and Venous Thromboembolism) Study included adults with AF newly starting warfarin between 2004 and 2007 within 5 health delivery systems in the United States. Diagnosed anxiety and depression and other patient characteristics were identified from electronic health records. We identified stroke and bleeding outcomes from hospitalization databases using validated International Classification of Diseases, Ninth Revision (ICD-9), codes. We used multivariable Cox regression to assess the relation between anxiety and/or depression with outcomes after adjustment for stroke and bleeding risk factors. In 25 570 adults with AF initiating warfarin, 490 had an ischemic stroke or intracranial hemorrhage (1.52 events per 100 person-years). In multivariable analyses, diagnosed anxiety was associated with a higher adjusted rate of combined ischemic stroke and intracranial hemorrhage (hazard ratio, 1.52; 95% confidence interval, 1.01-2.28). Results were not materially changed after additional adjustment for patient-level percentage of time in therapeutic anticoagulation range on warfarin (hazard ratio, 1.56; 95% confidence interval, 1.03-2.36). In contrast, neither isolated depression nor combined depression and anxiety were significantly associated with outcomes. Diagnosed anxiety was independently associated with increased risk of combined ischemic stroke and intracranial hemorrhage in adults with AF initiating warfarin that was not explained by differences in risk factors or achieved anticoagulation quality.

Published
2018

14. PHYSICIAN ASSESSMENT OF AORTIC STENOSIS SEVERITY AND LONG-TERM OUTCOMES: RESULTS FROM THE KP-VALVE PROJECT

Author

Solomon, Matthew D., primary, Tabada, Grace H., additional, Sung, Sue Hee, additional, Allen, Amanda, additional, Mishell, Jacob M., additional, Rassi, Andrew N., additional, McNulty, Edward J., additional, Philip, Femi, additional, Lange, David Christopher, additional, Ambrosy, Andrew P., additional, Zaroff, Jonathan G., additional, Krishnaswami, Ashok, additional, Lee, Catherine, additional, DeMaria, Anthony N., additional, and Go, Alan S., additional

Published
2023
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15. Management of Adults with Newly Diagnosed Atrial Fibrillation with and without CKD

Author

Bansal, Nisha, Zelnick, Leila R., Reynolds, Kristi, Harrison, Teresa N., Lee, Ming-Sum, Singer, Daniel E., Sung, Sue Hee, Fan, Dongjie, and Go, Alan S.

Subjects
Adult, Aged, 80 and over, Male, Anticoagulants, General Medicine, Middle Aged, Severity of Illness Index, Cohort Studies, Clinical Research, Nephrology, Atrial Fibrillation, Multivariate Analysis, Humans, Female, Warfarin, Renal Insufficiency, Chronic, Anti-Arrhythmia Agents, Aged, Glomerular Filtration Rate
Abstract

BACKGROUND: Atrial fibrillation (AF) is highly prevalent in CKD and is associated with worse cardiovascular and kidney outcomes. Limited data exist on use of AF pharmacotherapies and AF-related procedures by CKD status. We examined a large “real-world” contemporary population with incident AF to study the association of CKD with management of AF. METHODS: We identified patients with newly diagnosed AF between 2010 and 2017 from two large, integrated health care delivery systems. eGFR (≥60, 45–59, 30–44, 15–29, 60 ml/min per 1.73 m(2), patients with eGFR 30–44 (adjusted hazard ratio [aHR] 0.91; 95% CI, 0.99 to 0.93), 15–29 (aHR, 0.78; 95% CI, 0.75 to 0.82), and 60 ml/min per 1.73 m(2). These associations were even stronger for eGFR 60 ml/min per 1.73 m(2)): eGFR 30–44 ml/min per 1.73 (aHR, 0.78; 95% CI, 0.70 to 0.87), eGFR 15–29 ml/min per 1.73 m(2) (aHR, 0.73; 95% CI, 0.61 to 0.88), and eGFR

Published
2022

23. HIV Infection and Risks of Morbidity and Death in Adults with Incident Heart Failure

Author

Avula, Harshith R, primary, Ambrosy, Andrew P, additional, Silverberg, Michael J, additional, Reynolds, Kristi, additional, Towner, William J, additional, Hechter, Rulin C, additional, Horberg, Michael, additional, Vupputuri, Suma, additional, Leong, Thomas K, additional, Leyden, Wendy A, additional, Harrison, Teresa N, additional, Lee, Keane K, additional, Sung, Sue Hee, additional, and Go, Alan S, additional

Published
2021
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24. A Natural Language Processing–Based Approach for Identifying Hospitalizations for Worsening Heart Failure Within an Integrated Health Care Delivery System

Author

Ambrosy, Andrew P., primary, Parikh, Rishi V., additional, Sung, Sue Hee, additional, Narayanan, Anand, additional, Masson, Rajeev, additional, Lam, Phuong-Quang, additional, Kheder, Kevin, additional, Iwahashi, Alan, additional, Hardwick, Alexander B., additional, Fitzpatrick, Jesse K., additional, Avula, Harshith R., additional, Selby, Van N., additional, Shen, Xian, additional, Sanghera, Navneet, additional, Cristino, Joaquim, additional, and Go, Alan S., additional

Published
2021
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25. Triglyceride Levels and Residual Risk of Atherosclerotic Cardiovascular Disease Events and Death in Adults Receiving Statin Therapy for Primary or Secondary Prevention: Insights From the KP REACH Study

Author

Ambrosy, Andrew P., primary, Yang, Jingrong, additional, Sung, Sue Hee, additional, Allen, Amanda R., additional, Fitzpatrick, Jesse K., additional, Rana, Jamal S., additional, Wagner, Jeffrey, additional, Philip, Sephy, additional, Abrahamson, David, additional, Granowitz, Craig, additional, and Go, Alan S., additional

Published
2021
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26. THE USE OF NATURAL LANGUAGE PROCESSING-BASED ALGORITHMS AND OUTPATIENT CLINICAL ENCOUNTERS FOR WORSENING HEART FAILURE: INSIGHTS FROM THE UTILIZE-WHF STUDY

Author

Ambrosy, Andrew P., primary, Parikh, Rishi, additional, Sung, Sue Hee, additional, Narayanan, Anand, additional, Masson, Rajeev, additional, Lam, Phuong-Quang, additional, Kheder, Kevin, additional, Iwahashi, Alan, additional, Hardwick, Alexander, additional, Fitzpatrick, Jesse, additional, Avula, Harshith, additional, Shen, Xian, additional, Sanghera, Navneet, additional, Cristino, Joaquim, additional, and Go, Alan, additional

Published
2021
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27. GLOBAL CARDIOVASCULAR RISK ASSESSMENT IMPROVES RISK STRATIFICATION FOR MAJOR ADVERSE CARDIAC EVENTS ACROSS A WIDE RANGE OF TRIGLYCERIDE LEVELS IN STATIN-TREATED INDIVIDUALS: INSIGHTS FROM THE KP REACH STUDY

Author

Ambrosy, Andrew P., primary, Yang, Jingrong, additional, Fitzpatrick, Jesse, additional, Wagner, Jeffrey, additional, Kong, Jeremy, additional, Sung, Sue Hee, additional, Allen, Amanda, additional, Philips, Sephy, additional, Granowitz, Craig, additional, Abrahamson, David, additional, and Go, Alan, additional

Published
2021
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30. Food security, diet quality, nutritional knowledge, and attitudes towards research in adults with heart failure during the COVID‐19 pandemic.

Author

Ambrosy, Andrew P., Malik, Umar I., Leong, Thomas K., Allen, Amanda R., Sung, Sue Hee, and Go, Alan S.

Subjects
COVID-19 pandemic, VEGETARIANS, FOOD security, HEART failure, COVID-19, ADULTS, CARDIAC research
Abstract

Background: The impact of the novel coronavirus disease 2019 (COVID‐19) pandemic on diet and nutrition among older adults with chronic medical conditions have not been well‐described. Methods: We conducted a survey addressing (1) food access, (2) diet quality and composition, (3) nutritional understanding, and (4) attitudes towards research among adults with heart failure (HF) within an integrated health system. Adults (≥18 years) with diagnosed HF and at least one prior hospitalization for HF within the last 12 months were approached to complete the survey electronically or by mail. Outcomes included all‐cause and HF‐specific hospitalizations and all‐cause death was ascertained via the electronic health record. Results: Among 1212 survey respondents (32.5% of eligible patients) between May 18, 2020 and September 30, 2020, mean ± SD age was 77.9 ± 11.4 years, 50.1% were women, and median (25th–75th) left ventricular ejection fraction was 55% (40%–60%). Overall, 15.1% of respondents were food insecure, and only 65% of participants answered correctly more than half of the items assessing nutritional knowledge. Although most respondents were willing to participate in future research, that number largely declined for studies requiring blood draws (32.2%), study medication (14.4%), and/or behavior change (27.1%). Food security, diet quality, and nutritional knowledge were not independently associated with outcomes at 90 or 180 days. Conclusion: In a cohort of older adults with HF and multiple comorbidities, a significant proportion reported issues with food access, diet quality, and nutritional knowledge during the COVID‐19 pandemic. Future research should evaluate interventions targeting these domains in at‐risk individuals. Key points: Upwards of 15% of respondents screened positive for food insecurity, and only approximately 65% of respondents answered more than half of the items correctly on a questionnaire assessing nutritional understanding.Although the majority of respondents indicated that would be willing to consider participating in future research, that proportion declined markedly for studies requiring blood draws, study drugs, and/or behavior change.None of the functional domains assessed by this survey were independently associated with clinical outcomes in our cohort. [ABSTRACT FROM AUTHOR]

Published
2022
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35. Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The Cardiovascular Research Network Venous Thromboembolism (CVRN VTE) Study

Author

Fang, Margaret C, Fan, Dongjie, Sung, Sue Hee, Witt, Daniel M, Schmelzer, John R, Williams, Marc S, Yale, Steven H, Baumgartner, Christine, and Go, Alan S

Subjects
610 Medicine & health
Abstract

BACKGROUND Few studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the US. METHODS A multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism and/or deep venous thrombosis during years 2004 through 2010 was established from four large, US-based integrated healthcare delivery systems. Computerized databases were accessed and medical records reviewed to collect information on patient demographics, clinical risk factors, initial antithrombotic treatment, and vital status. Multivariable Cox regression models were used to estimate the risk of death at 90days. RESULTS The cohort comprised 5497 adults with acute venous thromboembolism. Pulmonary embolism was predominantly managed in the hospital setting (95.0%) while 54.5% of patients with lower extremity thrombosis were treated as outpatients. Anticoagulant treatment differed according to thromboembolism type: 2715 (93.7%) of patients with pulmonary embolism and 1634 (87.4%) of patients with lower extremity thrombosis were discharged on anticoagulants, compared to 288 (80.7%) patients with upper extremity thrombosis and 70 (55.6%) patients with other thrombosis. While 4.5% of patients died during the index episode, 15.4% died within 90days. Pulmonary embolism was associated with a higher 90-day death risk than lower extremity thrombosis (adjusted hazard ratio [aHR] 1.23 [1.04-1.47]) as was not being discharged on anticoagulants (aHR 5.56 [4.76-6.67]). CONCLUSIONS In this multicenter, community-based study of patients with acute venous thromboembolism, anticoagulant treatment and outcomes varied by thromboembolism type. Although case-fatality during the acute episode was relatively low, 15.4% of people with thromboembolism died within 90days of the index diagnosis.

Published
2019
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39. Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter‐Defibrillators in the Cardiovascular Research Network

Author

Greenlee, Robert T., primary, Go, Alan S., additional, Peterson, Pamela N., additional, Cassidy‐Bushrow, Andrea E., additional, Gaber, Charles, additional, Garcia‐Montilla, Romel, additional, Glenn, Karen A., additional, Gupta, Nigel, additional, Gurwitz, Jerry H., additional, Hammill, Stephen C., additional, Hayes, John J., additional, Kadish, Alan, additional, Magid, David J., additional, McManus, David D., additional, Multerer, Deborah, additional, Powers, J. David, additional, Reifler, Liza M., additional, Reynolds, Kristi, additional, Schuger, Claudio, additional, Sharma, Param P., additional, Smith, David H., additional, Suits, Mary, additional, Sung, Sue Hee, additional, Varosy, Paul D., additional, Vidaillet, Humberto J., additional, and Masoudi, Frederick A., additional

Published
2018
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41. Initial Management and Outcomes after Superficial Thrombophlebitis: The CVRN VTE Study

Author

Samuelson, Bethany, Go, Alan S., Sung, Sue Hee, Fan, Dongjie, and Fang, Margaret C.

Subjects
Male, Anticoagulants, Disease Management, Humans, Female, Venous Thromboembolism, Middle Aged, Thrombophlebitis, Pulmonary Embolism, Article, California, Platelet Aggregation Inhibitors, Retrospective Studies
Abstract

Although superficial thrombophlebitis (SVTE) is generally considered a benign, self-limited disease, accumulating evidence suggests that it often leads to more serious forms of venous thromboembolism. We reviewed the medical charts of 329 subjects with SVTE from the Cardiovascular Research Network Venous Thromboembolism cohort study to collect information on the acute treatment of SVTE and subsequent diagnosis of deep venous thrombosis within 1 year. All participants received care within Kaiser Permanente Northern California, a large, integrated healthcare delivery system. Fourteen (4.3%) subjects with SVTE received anticoagulants, 148 (45.0%) were recommended antiplatelet agents or nonsteroidal anti-inflammatory drugs, and in 167 (50.8%) there was no documented antithrombotic therapy. In the year after SVTE diagnosis, 19 (5.8%) patients had a subsequent diagnosis of a deep venous thrombosis or pulmonary embolism. In conclusion, clinically significant venous thrombosis within a year after SVTE was uncommon in our study despite infrequent use of antithrombotic therapy. Journal of Hospital Medicine 2016;11:432-434. © 2016 Society of Hospital Medicine.

Published
2016

48. Abstract 16941: Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter Defibrillators (ICDs): Insights From the Cardiovascular Research Network Longitudinal Study of ICDs

Author

Greenlee, Robert T, primary, Go, Alan S, additional, Magid, David J, additional, Peterson, Pamela N, additional, Cassidy-Bushrow, Andrea E, additional, Gaber, Charles, additional, Garcia-Montilla, Romel, additional, Glenn, Karen A, additional, Gupta, Nigel, additional, Gurwitz, Jerry H, additional, Hammill, Stephen C, additional, Hayes, John J, additional, Kadish, Alan, additional, McManus, David D, additional, Multerer, Deborah, additional, Powers, J. David, additional, Reifler, Liza M, additional, Reynolds, Kristi, additional, Schuger, Claudio, additional, Sharma, Param P, additional, Smith, David H, additional, Suits, Mary, additional, Sung, Sue Hee, additional, Varosy, Paul D, additional, Vidaillet, Humberto J, additional, and Masoudi, Frederick A, additional

Published
2015
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